The OBR Blog

As of September 23, 2010, patients can now access online their own versions of the NCCN guidelines for cancer treatment. The patient guidelines unveiled last week at a media teleconference are for treatment of breast and non-small-cell lung cancer (NSCLC), and guidelines for other cancer sites will soon be forthcoming. The NCCN Guidelines for Patients(TM) are specifically designed for patients to help navigate the complex journey of cancer care. Patients and their caregivers can use the Guidelines for discussions and shared decision-making with physicians, as well as a tool to gain insurance coverage for treatments that might not otherwise be covered.

NCCN professional guidelines are developed by 900 experts at 21 of the world’s leading cancer centers and are used worldwide as a “bible” for clinical decision-making in cancer care. As a side benefit, doctors and patients have used them to secure insurance coverage for recommended treatments. Now cancer patients will have their own versions of the very same high-quality, evidence-based information at their fingertips.

The Guidelines for patients will be available online at http://www.nccn.com as well as via a link on the Susan G. Komen for the Cure website (Komen). “The patient guidelines could not have been developed without the financial support from the Komen foundation, which provided $160,000 for development and distribution,” said William T. McGivney, PhD, CEO of NCCN.

NCCN will have at least six different cancer site-specific patient guidelines available online by the end of 2010, and guidelines for other common cancers are planned for roll out next year. Granted, the patient guidelines are written for sophisticated, educated patients—an audience that has access to computers and is “Internet savvy”—but these are the patients who are usually more knowledgeable about the latest treatments and are usually pro-active about their cancer care. Patricia J. Goldsmith, Executive Vice President and COO of NCCN also explained that a less complex set of treatment summaries for many cancers are available for patients on the NCCN website.

“It is important to let clinicians know that [in addition to the more sophisticated patient guidelines] these simpler treatment summaries are available for both patients and caregivers,” she added.

Today’s Patients

“Gone are the days of withholding diagnosis from patients or handing out bite-size portions of information and expecting passive acceptance. Today’s patients are and should be active information seekers and active partners. The norm is for patients to be knowledgeable and involved in care,” stated Al B. Benson, MD, a GI cancer specialist involved with NCCN since its inception.

“These patient guidelines are another giant step to give patients access to the same information that doctors use to make their decisions. Patients can get these online and initiate/participate in discussions with their doctors,” Benson commented.

The plan is to also have hard copies of the guidelines that can be ordered online or over the telephone. “The availability of hard copies will depend on the success of funding,” Goldsmith said. Currently, 10,000 hard copies of the patient guidelines for breast cancer and 5,000 for lung cancer have been printed.

Off-Label Drugs, Updates

The patient Guidelines will contain the same information as the professional Guidelines regarding off-label use of drugs, and updates will be incorporated in the same manner. When important studies are released that warrant inclusion in the Guidelines, changes will be incorporated in the online versions of both the professional and the patient Guidelines in a timely manner, and print versions will follow suit.

NCCN is accustomed to incorporating changes in the professional Guidelines. “For example, this year, we had four changes for breast cancer,” Goldsmith noted.

The lung cancer Guidelines are named in honor of Dana Reeves, who died in 2006 of lung cancer. Deborah Morosini, MD, Dana’s sister and a board member of NCCN, said that Dana understood the need for a national resource center for patients and their families.

“She spent many hours on the telephone and much of her energy trying to help people who wanted advice on spinal cord injury and paralysis after Christopher Reeve’s injury, and she wanted to develop a paralysis resource center. So these lung cancer patient Guidelines are a fitting tribute to Dana. They give people with a grim diagnosis a vehicle for finding out about new therapies they may not have known about,” said Morosini.

Last month, officials at Elekta hosted its ninth Medical Oncology EMR Summit at the Fairmont Hotel in downtown Chicago. It was an interactive forum, and attendees were presented with information on how to optimize their electronic medical records (EMRs) to provide more efficient patient care within their medical oncology practice. Dave Eggert, medical oncology business marketing manager for Elekta Impac Software, the Summit’s sponsor, told me the Summit drew over 240 attendees—“about one-third each from clinical, information technology, and administration fields.”

Insights into how practices can comply with new federal criteria as outlined under the HITECH Act were presented as were the latest features and functionality of MOSAIQ EMR software specifically designed for use in medical oncology and radiation oncology. Attendees got a close look at a new MOSAIQ software upgrade with Surescripts® certified, integrated ePrescribing functionality, which provides users with patients’ medication details.

“Application usability is one of our customers’ most important concerns,” Eggert told me, adding that customers want ePrescribing built into their product—“not as an external ‘add-on’ requiring another application and additional keystrokes to gain the benefit of ePrescribing.”

HITECH Update

Late-breaking HITECH news included changes in how physicians can qualify as eligible professionals, and updated timelines for adopting certified EHR technology and proving meaningful use. For details, access http://www.cms.gov/EHRIncentivePrograms/

Two important issues clarified were:
1.Despite some circulating misinformation, no programs or products are currently certified for EHR use.
2.The availability of certified EHR systems originally was expected by late fall of 2010, but this now seems doubtful, as the necessary committees are not yet in place.

Next-Generation Tumor Centers of Excellence

In a keynote address, David Katz, MD, executive director of The Advisory Board Company said “people tend to roll their eyes when someone mentions tumor centers of excellence.” Yet, more and more hospitals are developing these centers of excellence and seeking accreditation. In fact, an attendee told me that this session was one of her main reasons for attending the Summit.

Dr. Katz informed the audience that, “More than two-thirds of the 1,500 breast centers in the U.S. have expressed interest in accreditation.” According to The Oncology Roundtable of The Advisory Board Company, a survey of 188 hospitals showed that 53 percent had a fully developed, dedicated breast program; 37 percent were developing one, and 8 percent were in the planning stage, leaving only 3 percent with no program plans.

All outpatient procedures, currently the major profit-drivers in breast cancer services, are expected to increase. According to Dr. Katz, the increase will be led by breast MRIs, which is becoming “must have” technology.

Hospitals seeking accreditation need to meet or exceed industry standards, including providing rapid diagnoses. The Oncology Roundtable reported that at some centers the time from screening mammogram to surgery is as long as 21 days. In keeping with the government’s HITECH emphasis on enhancing the efficiency of patient health care, earlier diagnosis and characterization of disease helps to improve outcomes and reduce costs. Thus, this innovative planning of centers of excellence will allow hospitals to provide same-day follow-up from screening to diagnostic mammogram, then on to biopsy with diagnosis.

The increasing competition among hospitals and the growing importance of hospital accreditation will boost the demand for new EMR and EHR software applications tied to HITECH criteria. Already, ePrescribing is delivering better patient care with greater efficiency; additional innovative software applications are sure to follow.